endicott course - pennsylvania state university7/27/2016 1 endicott course developing and...

7/27/2016

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ENDICOTT COURSE

Developing and Implementing Successful Behaviorally Based

Social Skills for Individuals Diagnosed with Autism

Justin B. Leaf, Mitchell Taubman, John McEahin, Ronald Leaf,

Misty Oppenheim-Leaf, and Derek Ponce

Autism Partnership Foundation

7/27/2016

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RETRIEVAL • Go To:

• http://www.autismpartnership.com/conferences

• Scroll Down for Dr. Justin Leaf Presentations

• Title of Talk: NAC

• Password: NAC (All CAPS)

• Email: [email protected]

MY HISTORY

http://www.autismpartnership.com/conferenceshttp://www.autismpartnership.com/conferencesmailto:[email protected]

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MY HISTORY

MY HISTORY

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MY HISTORY

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WHAT ARE YOUR LONG TERM EXPECTATIONS?

THESE ARE MINE

• Marked Impairment in the Use of Multiple Nonverbal Behaviors (e.g., Eye-to-Eye Gaze, Facial Expression, Body Postures, Gestures)

• Failure to Develop Peer Relationships Appropriate to Developmental Level

• Lack of Spontaneous Seeking to Share Enjoyment, Interests, or Achievements with Other People

• Lack of Social or Emotional Reciprocity

SOCIAL DIAGNOSTIC CRITERIA

FOR AUTISTIC DISORDER

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WHY ARE TEACHING SOCIAL SKILLS IMPORTANT?

• Promote Language

• Improve School Performance (Ladd et al., 1999)

• Peer Approval (Bauminger & Kasari, 2000)

• Formation of Friendships (Bauminger & Kasari, 2000)

FRIENDSHIPS IN ASD

• Bauminger & Kasari (2000)

–Compared ASD to Typically Developing Children

–Utilized Friendship Qualities Scale

–Children reporting have friendship

–However Lower Quality

• Bauminger & Shulman (2003)

–Mothers perception

–High Functioning ASD vs Typically Developing

–Reported Friendships Across Both Groups

–ASD had fewer number, duration, and frequency

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FRIENDSHIPS IN ASD

• Orsmond, Krauss, & Seltzer (2004) – Investigated 235 Adolescents and Adults with ASD

– Low Quality of Friendships

WHY ARE TEACHING SOCIAL SKILLS IMPORTANT?

• Promote Language

• Improve School Performance (Ladd et al., 1999)

• Peer Approval (Bauminger & Kasari, 2000)

• Formation of Friendships (Bauminger & Kasari, 2000)

• Reduced Loneliness and Depression

• Reduce Thoughts or Attempts of Suicide

• Quality of Life

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WHY ARE SOCIAL SKILLS NOT A PRIORITY?

• “Students With ASD Aren’t Social ”

• Academic & Language Priorities

• Individuality

• “We Aren’t Social Ourselves”

• Interventionists Have Poor Social Skills

• It is Extremely Difficult to Teach

FRIENDSHIP ALGORITHM

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WHY ARE SOCIAL SKILLS NOT A PRIORITY?

• “Students With ASD Aren’t Social”

• Academic & Language Priorities

• Individuality

• Limited Social Curriculum

• “We Aren’t Social Ourselves”

• Interventionists Have Poor Social Skills

• It is Extremely Difficult to Teach

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EMPIRICALLY BASED INTERVENTIONS

• Non Empirically Based or Little Empirical Evidence • Social Thinking

• Social Stories (Gray & Garand, 1993)

• Empirical Evidence • Video Modeling (Apple, Billingsley, & Schwartz, 2005)

• Script Fading (e.g., Krantz & McClannahan, 1998)

• Peer Mediated Interventions (e.g., Goldstein, Schneider, & Theiman, 2007)

• Discrete Trial Teaching (e.g., Leaf & McEachin, 1999)

SOCIAL SKILLS GROUPS

• Overview • An Opportunity For Three or More Children to Come

Together and Simultaneously Learn Social Behaviors

• Advantages • Effective

• Peers in Close Proximity

• Efficient

• School Readiness

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PDF OF 1 TO 1 VS GROUP STUDY

LEVELS OF EVIDENCE

• Years of Clinical Experience

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HISTORY OF SOCIAL GROUP VIDEO

POLLYWOG VIDEO

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LEVELS OF EVIDENCE

• Years of Clinical Experience

• Descriptive Analysis

• Leaf et al., (2012)

• Sartini, Knight, & Collins (2013)

• Single Subject Designs

• Barry et al., (2003)

• Ferguson, Gills, Sevlever (2013)

• Group Designs

• DeRosier, Swick, Davis, McMillen, & Matthews (2011)

• Laugeson, Frankel, Gantman, Dillon, & Mogil (2012)

META ANALYSIS/REVIEWS

• White, Koenig, & Scahill (2007) • “A consistent result in the evaluation of group delivered intervention

to promote social reciprocity in children with PDDs is that outcome data are inconclusive”

• Rao, Beidel, & Murray (2008) • “… Despite its widespread clinical use, empirical support for social

skills training (SST) programs for children with AS/HFA is in its infancy ”

• Reichow & Volkmar (2010) • “Because social abilities are hindered in all individuals with ASD

regardless of functioning level, more research needs to be conducted…”

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META ANALYSIS/REVIEWS

• Cappadocia & Weiss (2011) • “Clearly, larger sample sizes and more controlled methodological

designs are required to assess the effectiveness of SSTGs.”

• Kaat & Lecavalier (2014) • “… more work is necessary before firm conclusions regarding the

efficacy of SST can be made.”

AREAS OF NEED

• Randomized Control Group Study

• “Higher” Functioning Participants

• Younger Children

• Comprehensive Assessments

• Blind Evaluators

• Generalization

• Long Term Maintenance

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PICTURES OF PENGUIN

PURPOSE OF THIS STUDY

• To Address These Areas of Need

• Using a Randomized Control Trial

• Evaluating a 16 week (32 session) Behaviorally Based Social Skills Group For High Functioning Individuals Diagnosed with ASD

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METHODS & RESULTS

GENERAL SET UP

INTERVIEW

RECRUITMENT

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INCLUSION CRITERION

• No Previous History

• Independent Diagnosis

• Low Level of Stereotypic Behaviors

• IQ score of 80 at Intake

• Age Appropriate • Expressive Language

• Receptive Language

INTERVIEWS

• Structured Interview

• 20 Minute Interview

• Two Teachers Present at All Times

• Another Child Came to Interact When Possible

• Characteristics

• Lack of Aberrant Behavior

• Speak in Full Sentences

• Answer Open-Ended Questions

• Interacted with Teacher or Peer For a Long Duration

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GENERAL SET UP

INTERVIEW

RECRUITMENT

GROUP A GROUP B

PARTICIPANT OVERVIEW

Domain Group A Group B P Value Significant Difference

Number of Participants

Meeting Inclusion

Criterion

8 7 N/A N/A

Average Age in Months 55 Months 58 Months 0.555 Not Significant

Average IQ Score 101.4 105.7 0.448 Not Significant

Average Vineland

Adaptive Score

83.9 82.9 0.918 Not Significant

Average Expressive 1

Word Standard Score


Average Peabody Picture

Vocabulary Standard

Score


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SOCIAL SKILLS GROUP TEACHERS

Teacher Name Education Level Position at AP Years of

Experience with

ABA

Years of

Experience at AP

Previous History

of Groups

Jeremy Masters Specialized

Treatment Analyst

5 Years 5 Years School Teacher

Group Leader

Christine First Year in

Terminal Masters

Program

Specialized

Treatment Analyst

5 Years 5 Years Group Leader

Donna Masters Intern 5 Years 10 Months None

Norma Bachelors

Treatment Analyst 3 Years 3 Years Group Support

DEPENDENT VARIABLES

• Improvement of Standard Scores on Formal Standardized Assessments

• Conducted By: • Social Skills Group Teachers

• Research

• Blind Evaluator

• Observational Periods

• Generalization Observations

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OBSERVATIONAL PERIODS: OVERVIEW • Who Participated

• Group A

• Group B

• Occurred • T1 (Baseline both)

• T2 (Immediately Following/Baseline)

• T3 (16 Week Maintenance/Immediately Following)

• T4 (32 Week Maintenance/16 Week Maintenance)

OBSERVATIONAL PERIODS: OVERVIEW • Two Meetings Per Group

• Each Meeting Lasted 2 Hours

• Resembled a Play Group

• Blind Evaluator Present

• Implemented to Assess Strengths and Weakness of Each Participant

• Utilized to Help Scoring on Formal Assessments

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OBSERVATIONAL PERIODS: SCHEDULE • Unstructured Free Play

• Opening Circle

• Structured Games

• Large Group Instruction

• Outdoors • Structured Games • Unstructured Free Play


• Unstructured Free Play

• Dismissal

GENERALIZATION PERIODS

• Settings • School

• Home

• Community

• Conducted Independently By • Researcher

• Social Skill Teacher

• Blind Evaluator

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FORMAL ASSESSMENTS

• Social Skills Improvement Systems (SSIS)

• Social Responsiveness Scale (SRS)

• Walker McConnell (WM)

GENERAL SET UP

INTERVIEW

RECRUITMENT

GROUP A GROUP B

OBSERVATIONAL PERIOD 1

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PRE-MUSICAL CHAIR VIDEO

TABLE OF DIFFERENCE Evaluator SSIS

Group A & Group B

T1

SRS

Group A & Group B T1

WM

Group A & Group B T1

Blind Evaluator No Significant Difference

P = 0.836

No Significant Difference

P = 0.831


P = 0.753

Social Skills Teacher No Significant Difference

P = 0.192


P = 0.572


P = 0.181

Researcher No Significant Difference

P = 0.298


P = 0.770


P = 0.703

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GENERAL SET UP

INTERVIEW

RECRUITMENT

GROUP A GROUP B


GROUP A INTERVENTION

TEACHING PROCEDURES

• Only ABA Based Strategies

• Structured but Flexible Approach

• Continuous Teaching

• Main Teaching Procedures • Group Discrete Trial Teaching

• 1 to 1 Discrete Trial Teaching (When Needed)

• Cool vs Not Cool Procedure

• Embedded Instructions

• Shaping

• Incidental Teaching

• Teaching Interaction Procedure

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CLINICAL SKILLS TAUGHT

• Behavioral Control

• Frustration Tolerance

• Recall

• Contingencies

• Attending

• Observational Learning

• Conditional Instructions

• Receptive Instructions

• “Figuring it Out”

• Play Areas

• Duck-Duck Goose

• Positive Affect

• Learning from Feedback

• Flexibility

• Delayed Instructions

• Rule Governed Play

• General Knowledge

• Pop Culture Knowledge

• Playing with A Friend

• Asking for Help

• Joining In

• Walking in Line

• Talking to a Friend

• Responding

• Being Silly

• Losing Graciously

• Trying

• Friendship Development

REINFORCEMENT SYSTEMS

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GENERAL SCHEDULE

• Arrival & Small Group Instruction


• Fun Games with Penguins

• Probes

• Teaching

• More Group Instruction

• Teaching Play

• Transition & Outdoors

• Cash In

GENERAL SET UP

INTERVIEW

RECRUITMENT

GROUP A GROUP B




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GENERAL SET UP

INTERVIEW

RECRUITMENT

GROUP A GROUP B




GROUP B INTERVENTION

GENERAL SET UP

INTERVIEW

RECRUITMENT

GROUP A GROUP B





GROUP B INTERVENTION


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RESULTS

SINGLE SUBJECT STUDIES

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GRAPH

Gabe

0

20

40

60

80

100

0

20

40

60

80

100

Sessions

0 5 10 15 20 25

0

20

40

60

80

100

Greg

0

20

40

60

80

100

0

20

40

60

80

100

Sessions

0 5 10 15 20 25

0

20

40

60

80

100

BL INT POST MAINT BL INT POST MAINT

Sleeping Game

Fruit

Salad

Mouse

Trap

GRAPH

AlexanderJoint Attention

0

20

40

60

80

100

AlexanderCommunication

0

20

40

60

80

100

AndyJoint Attention 0

20

40

60

80

100

AndyCommunication

Probes

0 10 20 30

0

20

40

60

80

100

Baseline Intervention Maintenance

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GROUP DESIGN STUDIES

SSIS

60

80

100

120

Social Skills Teacher

60

80

100

120

Researcher

1 2 3 4

60

80

100

120

Blind Evaluator

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SSIS

60

80

100

120

Social Skills Teacher

60

80

100

120

Researcher

1 2 3 4

60

80

100

120

Blind Evaluator

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SRS

Blind Evaluator 40

50

60

70

80

Social SkillsTeacher40

50

60

70

80

Researcher

1 2 3 4

40

50

60

70

80

Severe

Moderate

Mild

Normal

Severe

Moderate

Mild

Normal

Severe

Moderate

Mild

Normal

SRS

Blind Evaluator 40

50

60

70

80

Social SkillsTeacher40

50

60

70

80

Researcher

1 2 3 4

40

50

60

70

80

Severe

Moderate

Mild

Normal

Severe

Moderate

Mild

Normal

Severe

Moderate

Mild

Normal

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WM

Blind Evaluator 60

70

80

90

100

110

120

Social SkillsTeacher

60

70

80

90

100

110

120

Researcher

1 2 3 4

60

70

80

90

100

110

120

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WM

Blind Evaluator 60

70

80

90

100

110

120

Social SkillsTeacher

60

70

80

90

100

110

120

Researcher

1 2 3 4

60

70

80

90

100

110

120

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SOCIAL VALIDITY

• “We have loved being part of this study. Very impressed with the quality of teachers and instructions.”

• “He has most definitely made huge leaps and gains in his social awareness and standing amongst his peers especially the typical ones.”

• “He has made significant strides but he still has a little ways to go and again many of those strides were because of you guys and for that we thank you!!!”

• “We have we have seen a BIG difference thanks to you and the THERAPIST.”

SOCIAL VALIDITY Question Group A Group B Both Groups

Satisfaction Learning Social Skills 5.8 6.5 6.1

Satisfaction Learning Play Skills 5.8 6.5 6.1

Satisfaction Learning School Readiness Skills 6.2 6.75 6.4

Satisfaction with the Teachers 6.2 7 6.6

Satisfaction with Teachers Ability to Connect With Your Child 6.4 6.75 6.6

Satisfaction with the Communication 6 6.5 6.2

Satisfaction with the Teaching Procedures 6 6.75 6.3

Overall Satisfaction 6.4 7 6.1

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OVERVIEW OF RESULTS

• Clinical Results

• Single Subject Results

• Group Design Results

• Social Validity Results

• Overall Results

POST MUSICAL CHAIRS

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LESSONS LEARNED

WHAT TO LOOK FOR

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CLIENT CHARACTERSTICS

• Decide on Your Group • Age

• Functioning Level

• Group Goals

• Family Support

• Other Agencies

• Would Like Children to Be Similar

CLIENT TARGETED BEHAVIORS


• Expressive Language

• Social Awareness

• Social Desire

• Attending

• Contingencies

• Aberrant Behavior

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TEACHERS AND TRAINING

COMPONENTS OF QUALITY STAFF

• Fun

• Receptive

• Systematic

• Adaptable/Flexible

• Objective

• Analytic

• Engaging

• Professional

• Creative

• Reinforcing

• Widely Competent

• Big Picture vs Little Picture

• Child Driven

• Conceptual History

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CAL TEACHER VIDEO

STAFF TRAINING

• What Makes Some One Qualified? • Certification does Not Equal Qualified

• How Many Hours Does it Take to Be Qualified? • 40 Hours, 1500 Hours, 3000 Hours

• Competency Based, Not Time Based

• How Do You Get Someone Qualified • Didactic Instruction

• Hands on Training

• Years of Experience

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“It is what you learn after you know it all that counts”

John Wooden

TEACHING METHODS

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VARIOUS TEACHING METHODS

• Group Discrete Trial Teaching

• Cool vs Not Cool


• Embedded Instruction

• Incidental Teaching

REGARDLESS OF THE TEACHING • A Progressive Model

• Not Adhering to Set Protocols

• Structured yet Flexible Approach • Game Plan

• Call an Audible

• In-The-Moment Analysis • Constant Observations

• Across Multiple Domains

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GROUP DTT

• Three Term Contingency

• Flexible Prompt Fading

• Type of Discrete Trials • Sequential

• Random Sequential

• Choral

• Lead Teacher Responsibilities

• Shadow Teacher Responsibilities

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DORIS VIDEO

COOL VS NOT COOL

• A Social Discrimination Program

• Discriminate Between

• Appropriate Behavior (Cool)

• Inappropriate Behavior (Not Cool)

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COOL VERSUS NOT COOL VIDEO

COOL VS NOT COOL

• A Social Discrimination Program

• Discriminate Between • Appropriate Behavior (Cool) • Inappropriate Behavior (Not Cool)

• Used to Teach: • General Social Skills • Social Language • Reduction of Stereotypic Behavior • Reduction of SIB or Aggression • School Behavior

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CNC VIDEO WITH GROUP

THIRD CNC GROUP

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COOL VS NOT COOL

• Pre-Requisites • Attending

• Matching Skills

• Abstract Concepts


• How to Implement • Receptive Program

• Teacher Modeling

• Child Role-Playing


THE TEACHING INTERACTION PROCEDURE

“Teaching Interactions”

“TI’s”

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WHAT IS A TEACHING INTERACTION?

•A Multi-Component Teaching Strategy •Six Essential Steps: •Label and Identify •Rationale •Description and Demonstration •Practice •Feedback •Optional External Consequence

TEACHING INTERACTION VIDEO WITH RICK

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WHAT IS A TEACHING INTERACTION?

• An Interactive Teaching Procedure Between the Student and the Teacher • Structured, yet Flexible

• Active Participation

• Great Variation

LABELING AND IDENTIFICATION

• Inform the Student Of What Skill You Will Be Working On

• Clearly Define the Behavior

• When and Where the Student Should use the Skill

• When and Where the Student Should Not use the Skill

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MEANINGFUL RATIONALE

•Explains to the Student Why He or She Should Display the Behavior

•Usually Takes Form of an “If______Then___ Statement”

•Good Rationales Are: • Meaningful • Motivating • Fading of Reinforcement • Provide Self-Instruction

BEHAVIORAL STEPS

•Break Down into Smaller Skill Steps

•How Many Skill Steps?

•Each Skill Step can be on Opportunity for Discrimination Training. • Cool Versus Not Cool Program

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TEACHER DEMONSTRATION

• Teacher Displays the Behavior

• Correct Demonstration

• Incorrect Demonstration

• Should Resemble Real Life Situations

• Learner to Rate Demonstration

• Overall • Specific Skill Steps

• Should Program for Generalization with Multiple Exemplars

ROLE-PLAY

• Set Up Simulated Situations for the Student to Display the Behavior

• Initially, These Situations Should be Obvious • Student Should be Successful

• Over Time you Want to Expand to More Natural Situations

• This is the Key to Generalization

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FEEDBACK

• Immediate Positive Feedback

• Specific to 3 or 4 Things the Student did Correctly

• Followed by Specific Suggestion of What the Student Needs to Remember for the Next Time the Skill is Practiced

• Balance of Specific Feedback and Fun/Motivating Reinforcement

• Re-Practice if Necessary

EXTERNAL CONSEQUENCE (OPTIONAL)

• Ties Into the Student’s Motivational System

• Reinforcement Should be Enthusiastic and Individualized

• Might Involve Either Positive or Corrective Consequences

• Strengthens Motivation

• Enhances Feedback

• Faded Over Time

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GENERALIZATION TRAINING

• People

• Places

• Time

• Increasing Provocativeness

• Predictability

• Authenticity

• Reinforcement

TI KISSING VIDEO

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TI WITH KATHLEEN VIDEO

EMBEDED INSTRUCTIONS & INCIDENTIAL TEACHING • The Importance of Play

• Work on Multiple Skills Simultaneously

• Develop Peer Reinforcement

• Leave them With a Tool

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FRUIT SALAD

EMBEDED INSTRUCTIONS & INCIDENTIAL TEACHING • The Importance of Play

• Work on Multiple Skills Simultaneously

• Develop Peer Reinforcement

• Leave them With a Tool

• Incidental Teaching • Balance of Child Directed and Teacher Initiated

• Follow their Lead

• Flexibility

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REINFORCEMENT

Tangible Self

Monitoring

RANGE OF ABA

Individual

Token

Economy

Group

Token

Economy

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REINFORCEMENT SYSTEMS

• Catching Them Being Good

• Individual Token Economies • Special Reinforcement Area

• Moving Up the Chart

• Faded Out

• Behavioral Thermometer: “Cool Chart” • Treasure Chest

• Time-Out Ribbon

LEVEL VIDEO

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CURRICULUM

SELECTING CURRICULUM

• No Universal Curriculum

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SO MANY SKILLS THAT CAN BE TAUGHT

SELECTING CURRICULUM

• No Universal Curriculum

• Current State of Curriculum

• How Curriculum Should Be Selected

• Domains • Pre-Requisite Behaviors

• Social Play

• Social Language

• Social Interaction

• Social Relatedness

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PRE-REQUISITE

• Also Known As Learning to Learn Skills

• Help Get the Student Ready for Learning

• Variety of Skills • Attending

• Sitting

• Responding First Time

• Recall

• Contingency Development

• Reduction of Aberrant Behavior

CONTINGENCY DEVELOPMENT VIDEO

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PEER REINFORCEMENT DEVELOPMENT VIDEO

INITIAL JOINT ATTENTION VIDEO

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MORE ADVANCED JOINT ATTENTION VIDEO

WALKING VIDEO

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CONDITIONAL INSTRUCTIONS VIDEO

SOCIAL PLAY

• Indoor and Outdoor Free-Play

• Indoor and Outdoor Structured Play

• Social Behaviors Associated with Play

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PLAY INFERENCES VIDEO

MOUSE TRAP VIDEO

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SLEEPING GAME VIDEO

PRETEND PLAY VIDEO

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CRUSH VIDEO

PLAY VIDEO

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DATA COLLECTION, EVALUATION, AND

MEASURMENT

MULTIPLE MEASURES

• Formal Assessments

• SSiS

• SRS

• ABC

• Walker

• Observational Data

• We Avoid Trial by Trial

• Probe Data

• Naturalistic Probes with Task Analysis

• Estimation Data

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MULTIPLE MEASURES

• Formal Assessments • SSiS

• SRS • ABC • Walker

• Observational Data • We Avoid Trial by Trial • Probe Data • Naturalistic Probes with Task Analysis • Estimation Data

• Social Validity

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PARENTS AND PEERS

PARENTS AND PEERS

• Parents • Keep Them Involved

• Debrief Every Session

• Open-Door Policy

• Bi-Monthly Meetings

• Get Their Ideas

• Peers • Generally Do Not Use Siblings

• Treat As Any Other Member

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THANK YOU [email protected]
mailto:[email protected]

endicott course - pennsylvania state university7/27/2016 1 endicott course developing and...

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